Nephroblastoma (Wilms Tumor)
 a malignant tumor that rises from the
metanephric mesoderm cells of the upper
pole of the kidney.
 It accounts for 20% of solid tumors in
childhood; there is no increased incidence
based on sex or race.
CAUSES
 It occurs in association with congenital
anomalies such as aniridia (lack of color
in the iris), cryptorchidism, hypospadias,
pseudohermaphroditism, cystic kidneys,
hemangioma, and talipes disorders.
 A number of genes have been identifi ed
as associated with the disorder, e deletion
of chromosome 11.
 Without therapy, metastatic spread by the
bloodstream is most often to the lungs,
regional lymph nodes, liver, bone, and,
eventually, brain.
S/Sx
 Usually discovered early in life
(6 months to 5 years; peak at 3 to 4 years)
 although it apparently arises from an
embryonic structure present in the child
before birth
 Nephroblastomas distort the kidney
anteriorly so that the tumor is felt as a
firm, nontender abdominal mass. Parents
are aware their infant has a mass in the
abdomen but bring the infant to their
health care provider thinking that it is hard
stool from chronic constipation.
 Fathers may discover the tumor when they
toss a baby in the air, catch the infant by
the abdomen, and feel the abdominal
mass.
 Parents often report that the mass seemed
to appear overnight== This actually can
happen, because tumors can hemorrhage
into themselves, doubling their size in a
matter of hours.
 accompanying signs may be
hematuria and a low-grade fever.
 The child may be anemic from blood loss
and lack of erythropoietin formation by
the diseased kidney.
 Although hypertension may also occur
because of excessive renin production,
blood pressure is not taken routinely in
children of this age, so the tumor is rarely
discovered by this method.
Dx
 A CT scan or UTZ== reveals the primary
tumor and any points of metastasis.
 Kidney function studies
 glomerular filtration rate or blood
urea nitrogen== to assess function
of the kidneys before surgery.
MEDICAL MANAGEMENT
 Nephroblastomas are staged to predict
therapy and prognosis.
 Nephrectomy (excision of the affected
kidney).
 Followed immediately by radiation
therapy (omitted in stage I tumors) and by
chemotherapy with
 dactinomycin, doxorubicin, or
vincristine, cyclophosphamide,
and etoposide.
 Chemotherapy may be given at
varying intervals for as long as 15
months.
 A second surgical procedure may be
scheduled after 2 or 3 months to remove
any remaining tumor.
 If tumor involvement is bilateral, the
operative decisions obviously become
more complex.
 If the tumors are small, both tumors may
be removed, leaving functioning kidney
on both sides intact.
 In other children, the kidney with the
larger tumor is removed and the tumor
site in the remaining kidney is then
treated with both radiation and
chemotherapy.
NX MNGT
 Note; Little time can be allotted for
preoperative testing, because these tumors
metastasize rapidly as a result of the large
blood supply to the kidneys and adrenal
glands.
 It is important that the child’s abdomen
not be palpated any more than is necessary
for diagnosis, because handling appears to
 aid metastasis. Place a sign reading “No
Abdominal
 Palpation” over the child’s crib to help
prevent this.

COMPLICATIONS
 Nephritis
 small bowel obstruction
 hepatic damage caused by fi brotic
scarring from radiation can occur.
 In girls, radiation-related damage to the
ovaries may result in sterility.
 Radiation to the lungs may result in
interstitial pneumonia; spine radiation can
result in scoliosis.

PROGNOSIS
Overall therapy for nephroblastoma is so effective
that about 90% of children who had no metastatic
spread at diagnosis survive for at least 5 years.

A child on the same hospital unit as Gerri has nephroblastoma

(Wilms tumor). What is an important nursing intervention to
ensure the safety of a child with nephroblastoma before
surgery?
a. Post a sign over the crib stating, “No Abdominal
Palpation.”
b. Alert the mother that her child will be infertile after surgery.
c. Be certain the child eats no high-iron vegetables before
surgery.
d. Mark the child’s head circumference in the electronic
record daily